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813-780-0020 City of Zephyrhils Fee- f-0202-0Y Fax-813-780-0021 <br /> Permit Appkation --11 <br /> Date Reserved <br /> - Phone Contact for Pam* 1 ----- <br /> owners Name ....1,,, 4. ;:i1:1 II Jr /WM Owner's Phone Number 413 I 1 7J 1 leiert <br /> , <br /> 07.--- ..-4 <br /> Owner's Address 4. . <br /> ,1 ,,o AIIII -, . • g <br /> Fee Simple Titleholder Name 1 I 'Titleholder Phone Ntanber I 1 1 11 <br /> Fee Simple TItishoider Address 1 <br /> ,--,- - --..1.g-Azio- --.: "7.7.-' - '', -,, , - 4—... - -- ' - ' • -" ---'.= 17.0.= - . - - -- ,.-......,,,,77€1‘,..,„,„._ --"-----.- <br /> Job Address 1 I Lotft <br /> Sub Division I I Parcel* <br /> ED Bio-Hazard Waste Storage -ANNUAL r Fumigation Tent <br /> ED Comm Exhaust Kitchen Hood/Duct E:1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> D Controlled Bum F Hood Installation <br /> = Ernergency Generator <30 kw r-i LP/Natural Gas-Installation <br /> El Cs..9.....y Generator > 30 kw El LPINaturat Gas-ANNUAL Sale <br /> ri Fire Protection Maintenance - ANNUAL = Races of Assembly-ANNUAL <br /> . rani 1 5165 1 Ea 04 <br /> Sprinider Li o 0 0 17 Regional Bum <br /> Rre Alarm p 0 0 0 1 1 [J Spiders <br /> Hood Cleaning 0 0 X l 1 n SprinIder System Instlatio <br /> alns <br /> Hood Suppression [1 0 0 I 1 1 Standpipes (Sprinider Sys) <br /> Fire Alarm Installation El Tooth Roofingfrar Kettle <br /> Fire Pumps E Waste Tire Storage ANNUAL <br /> Are Works <br /> Flammable Appucation- ANNUAL <br /> 1 I Valuation of Project <br /> Fuel Tanks <br /> El Other: I <br /> Contractor Company <br /> • <br /> Signature Registeeed I Y / N I Fee current 1 Y / N 1 <br /> Address 1 . License* I I <br /> ELECTRICIAN! Company <br /> Signature Registered I Y/N 1 Fee Current 1 Y/N 1 <br /> Address I 1 License* 1 1 <br /> PLUMBER Company <br /> Signature 1 Registered I Y / N I FOB Currerd 1 Y / N I <br /> Address I License * 1. I <br /> MECHANICAL' Company <br /> Signature Registered I Y/N j Fee Currant 1 Y/N 1 <br /> Address 1 License* ) 1 <br /> OTHER <br /> Signaline -.1 ...'.f ,./ --Z-if:14(..A- <br /> .5 Company 1 t.., (2,,-,,,—r-- <br /> Registered MA 1 'Fee Ctsrent 1 Y 1 N j <br /> Address Megirigniff _MMEIRMINIWillWrolVEIIII license # c Z. — -- esc..c_.> 12_ <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of appNcation, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Commencement is raquked (Mechanical v.virk over $5000) <br /> Supply two (2) sets of drawings with applicable documerdation <br /> Allow 10-14 days for review after submittal date. Parcel # - obtained from Properly Tax Notice (http://appraiser.pascogov.com) <br />